Well, Phil, thanks for your persistence. Why do i think my cancer treatment should be different? How entitled of me to expect a personalized, evidence-based medical approach in the 21st century—after all, it’s only my life on the line.

Let’s rewind to the beginning. After my biopsy, it seems the curiosity ended there. No genetic testing. Because who needs to know if i have BRCA mutations or other hereditary markers that might scream, “Hey, this cancer might be more aggressive than it looks!”? No big deal—just roll the dice and hope for the best. It’s not like genomics has revolutionized oncology or anything.

And testosterone levels? Pfft. Why would anyone look into my hormonal history when dealing with a hormone-driven cancer? Clearly, establishing a baseline testosterone level before starting androgen deprivation therapy would be far too logical. Better to just throw Firmagon at the problem and hope my endocrine system doesn’t throw a tantrum.

Let’s not forget the total absence of comprehensive risk stratification. Cribriform patterns? Perineural invasion? Gleason 7? PSA of 26? All very exciting, but rather than contextualizing these in the broader biological narrative of my body, the system seems to have said, “Good enough for government work. Let’s treat this like every other moderately aggressive case.” Individual variation? Overrated.

No deep dive into family history, lifestyle factors, comorbidities beyond the checkbox exercise. No real effort to integrate cardiac risk into the treatment equation until I politely reminded them that my heart is not just decorative. Because apparently, oncologists think my heart will just sit quietly in the corner while my prostate gets all the attention.

So why do i think my treatment should’ve been different? Because treating prostate cancer—an inherently heterogeneous disease—like it’s a one-size-fits-all, color-by-numbers project is a fabulous way to miss critical nuances. My treatment should have incorporated those missing variables because, shockingly, they matter. They guide not only treatment choice but timing, sequencing, potential synergy, and side effect mitigation. Ignoring them is like planning a mission to Mars with a weather forecast for Miami.

The consequences of skipping those early steps? Over- or undertreatment, increased risk of recurrence, avoidable side effects, poorer quality of life, missed opportunities for targeted therapy, and, of course, a nagging sense that the system treated the cancer, but forgot there was a human attached to it.

It’s not as if I haven’t flagged it. It was just ignored, because, you know, “I am a doctor and who the f are you?”. The rest of my opinions about my fine radiation oncologist are illustrated in other posts.